Sleep eating

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Overview

Sleep eating is a sleep-related disorder, although some specialists consider it to be a combination of a sleep and an eating disorder. It is a relatively rare and little known condition that is gaining recognition in sleep medicine. Other names for sleep eating are sleep-related eating (disorder), nocturnal sleep-related eating disorder (NS-RED), and sleep-eating syndrome.

Sleep eating is characterized by sleepwalking and excessive nocturnal overeating (compulsive hyperphagia). Sleep eaters are comparable to sleepwalkers in many ways: they are at risk for self-injury during an episode, they may (or may not) experience excessive daytime sleepiness, and they are usually emotionally distressed, tired, angry, or anxious. Sleep eaters are also at risk for the same health complications as compulsive overeaters, with the added dangers of sleepwalking. Common concerns include excessive weight gain, daytime sleepiness, choking while eating, sleep disruption, and injury from cooking or preparing food such as from knives, utensils, or hot cooking surfaces. There is also the potential for starting a fire.

As with sleepwalkers, sleep eaters are unaware and unconscious of their behavior. If there is any memory of the episode, it is usually sketchy. A sleep eater will roam the house, particularly the kitchen, and may eat large quantities of food (as well as non-food items). In the morning, sleep eaters have no recollection of the episode. However, in many cases there are clues to their behavior. One woman woke up with a stomachache and chocolate smeared on her face and hands. Candy wrappers littered the kitchen floor. The next morning her husband informed her that she had been eating during the night. She was shocked and distressed because she had no recollection of the event.

As in the case described above, food consumed by sleep eaters tends to be either high sugar or high fat. Odd combinations of foods, such as potato chips dipped in peanut butter or butter smeared on hotdogs, as well as non-food items, have been reported. Oddly, one person was discovered cutting a bar of soap into slices and then eating it as if it were a slice of cheese!

Sleep eating is classified as a parasomnia. It is a rare version of sleepwalking, which is an arousal disorder.

Causes

There is really no one cause of Sleep Eating Disorder, however people with some particular histories appear to be at a higher risk of acquiring the disorder.

There are some of the correlations that have been found among people suffering from SED.

1. Sleep Walking: People who sleep walked as children are at higher risk of acquiring SED than those who did not. This is true whether they continued to sleep walk passed childhood or not.
2. Sufferers Of Other Sleep Disorders: There is a high correlation among people who suffer from other sleep disorders and SED. These disorder include;

1. • Narcolepsy
   • Restless Leg Syndrome & Periodic Limb Movement Narcolepsy
   • Obstructive Sleep Apnea

1. People On Some Particular Medication: Medications especially those used to treat depression and insomnia appear to increase the SED risk factor. Clinical studies show a strong link between SED and insomnia drug zolpidem (Ambien).
2. Other Eating Disorders & Dieting
3. Addictive Substance withdrawal: For example alcohol, nicotine and some painkillers.
4. Stress: SED can be triggered by a bout of excessive stress normally persists long after the stress is gone.
5. 'Going to bed hungry: This may be a tricky cause to understand. In some people sleeping on an empty stomach can trigger SED. Others may actually suffer from SED but have it masked by the fact that they sleep on full stomach. For the first case, SED becomes a behavioral problem, and it may be corrected by simply eliminating the cause i.e. sleeping while hungry. This may have to be done for a prolonged period of time before it can go away, but such people will remain vulnerable to future bouts of SED if they start sleeping on empty stomach. For the later group, the empty stomach isn't the problem, it just reveals the disorder. '

It should be noted that it is not uncommon for someone to suffer from SED without having a history of any of the above high risk factors.

Epidemiology and Demographics

The actual number of sleep-eating sufferers is unknown; however, it is estimated that 1 to 3 percent of the population is affected by sleep eating. A higher percentage of persons with eating disorders, as many as 10 to 15 percent, are affected. For this reason, sleep eating is more common in younger women. Symptoms typically begin in the late 20s. Episodes may reoccur, in combination with a stressful situation, or an episode may occur only once or twice. Additionally, many parasomnias seem to run in families, which may indicate that sleep eating is genetically linked.

Natural history, Complications and Prognosis

Like any other disorder, SED does have a handful of consequences that might come up among the patients. If you are suffering from the disorder you may expect any of the following;

Weight Gain

SED is in part an eating disorder, so if ones body is prone to weight gain the disorder may bring it out, worsen it or make it hard to combat if one is trying to fight it. The weight gain is in large part attributed to eating foods with high calorie content. Add to that eating the food in the middle of ones sleep without any other activity to burn the calories and weight gain problem is multiplied many times over.

Insomnia

Night episodes tend to occur in middle of heavy sleep cycles(REM). Interfering with REM cycles deprives the body of a significant amount of recuperation time so much so that a 10 minute may bring about tiredness during the day that would otherwise be related to little or no sleep.

Food Poisoning

One of the symptoms of sleep eating disorder is that patients may consume items not meant to be eaten during the night episodes. This can easily lead to food poisoning, and because it may go on for many consecutive nights even minor intakes of harmful items may build up to a toxic level in the body.

Reduced Control Of Diabetes and Increased cholesterol

This should come as no suprise that eating high sugar and high calorie foods makes controlling ones body sugar levels and cholesterol difficult.

Depression

The nature of SED and some of the consequences(especially the first two) is that it can induce a depression in patients.

Poor Nutrition

Many patients tend to compensate for the disorder by reducing their food consumption during the day, since only a certain type of foods are consumed during the night episodes, the patients soon find themselves lacking vital nutritional elements in the body.

Diagnosis

In 1968, Roger Broughton published a paper in Science (159: 1070-1078) that outlined the major features of arousal disorders. They are:

• Abnormal behavior that occurs during an arousal from slow wave sleep;
• The absence of awareness during the episode;
• Automatic and repetitive motor activity;
• Slow reaction time and reduced sensitivity to environment;
• Difficulty in waking despite vigorous attempts;
• No memory of the episode in the morning (retrograde amnesia); and
• No or little dream recall associated with the event.

History and Symptoms

It is well accepted that the symptoms for sleep eating disorder tend to vary among the patients. However, the episodes tend to have a number of common characteristics.

These characteristics include

• Episodes only occur during the night and not during naps.
• The foods consumed tend to be of high calorie content but may also contain other house hold items that are not meant to be consumed like soap. Also some foods are consumed in a manner not preferred by the patients for example taking licking lots of sugar, drinking syrup(e.g. pan cake syrup) and various other twists.
• The episodes occur frequently, like every night, and in more cases happening more than once a night.
• The episodes last very short times 5 – 10 minutes. However some patients may have longer episodes where they even cook, but these are not common. During this time the food is eaten very fast.
• Alcoholic beverages are not normally consumed during the episodes.
• Without any evidence the patients do not recall the episodes and many times will not recall even with evidence, however it is not uncommon for the evidence to trigger some memories of the episode.
• Studies have also shown that it is difficult to awaken the sufferer during an episode.
• Patients tend to follow specific routines during the episodes. The routines can change for example, a patient may consume 5 foods in the same order for 20 consecutive episodes, then switch the foods around for next 15 episodes and so on. However, since a patient may not always have access to the same foods all the time, they tend to improvise to cater for what is missing.

Treatment

The first step in treating any sleep disorder is to ascertain any underlying causes. As with most parasomnias, sleep eating is usually the result of an underlying problem, which may include another sleep disorder, prescription drug abuse, nicotine withdrawal, chronic autoimmune hepatitis, encephalitis (or hypothalmic injury), or acute stress.

It is important to keep in mind that throughout life, people experience varying patterns of sleep and nutrition during positive and negative situations. Problems with eating are defined as overeating or not eating enough. Problems with sleeping can be simplified with two symptoms, too much or not enough sleep. Medical attention is required for abnormal behaviors in either or both areas.

For some people who have been diagnosed with sleep eating, interventions without the use of medications have proven helpful. Courses on stress management, group or one-on-one counseling with a therapist, or self-confidence training may alleviate the stress and anxiety that leads to nighttime bingeing. Although considered an alternative treatment, hypnosis may be an option for some sleep eaters. A change in diet that includes avoiding certain foods and eating at specified times of the day, as well as reducing the intake of caffeine or alcohol, may be therapeutic. Professional advice may also suggest avoiding certain medications.

If the underlying problem is diagnosed as sleepwalking, medications in the benzodiazepinefamily have had some success. In sleepwalkers, this class of drugs reduces motor activity during sleep. Another class of drug found to be effective for sleep eaters has been the dopaminergic agents such as Sinemet (carbidopa or levodopa) and Mirapex (pramipexole dihydrochloride).